The Impact of Circumcision on HIV Acquisition and HSV Recurrences

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The Impact of Circumcision on HIV Acquisition and HSV Recurrences

Thomas C. Quinn, M.D.
The Johns Hopkins University and NIAID, NIH, Baltimore, MD, USA.

Ecologic and epidemiologic studies have demonstrated that male circumcision is associated with decreased HIV acquisition. Three randomized clinical trials of male circumcision in South Africa, Uganda and Kenya definitively proved that circumcision reduces the risk of HIV infection by 50 to 60%, identical to that observed in meta-analyses of over 35 epidemiologic studies. All three trial also showed a reduction of genital ulcer disease by 50%, suggesting that part of the observed decreased susceptibility to HIV infection may be an indirect effect of reduction in genital ulcer disease due to HSV, syphilis, and/or chancroid. In a meta-analysis of 10 published articles that specifically examined the association of male circumcision and HSV-2 serostatus, circumcised men were found to have lower rates of HSV-2 seropositivity on univariate analysis in six studies and the association was statistically significant (p < 0.05) in three of these. Adjusting for age and other potential confounders, the summary relative risk was 0.88 (CI 0.77—1.01). In two subsequent population based studies in New Zealand and the U.S., infant circumcision was not associated with a reduction in HSV-2 seropositivity later in life, although a small effect cannot be ruled out. In the Kenyan trial of male circumcision, while GUD was reduced by 50% mostly due to a reduction in recurrences of HSV-2, there was no apparent effect on HSV-2 serologic incidence. In the Rakai RCT, GUDs, primarily caused by HSV (66%) were reduced by 50% in the circumcised men. Serologic evidence for HSV-2 seroconversion by trial arm is pending but baseline serologic evidence suggests that herpetic recurrences were reduced significantly in the circumcised men.

In summary, male circumcision does not appear to significantly reduce susceptibility to incident HSV-2 but does appear to reduce the recurrence rate of genital ulcers. Further studies are warranted to determine the potential benefit of circumcision in efforts to reduce the incidence and/or recurrence rate of genital HSV-2 infection.

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Last Updated : 03/12/2007 18:19:38